CommercialPrior AuthMedium impact
Oral Acne Antibiotics (Revised)
Humana·Dermatology, Pharmacy, General Practice +2 more·Commercial
Effective date
Apr 24, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its Oral Acne Antibiotics step therapy policy (effective April 24, 2024) to implement a two-criterion prior authorization requirement. Members must have prior treatment history with both a non-delayed release minocycline formulation AND a non-delayed release doxycycline formulation before coverage is approved for listed oral acne antibiotics. This is a step therapy policy affecting 18 covered medications.
Action Required
By May 24, 2024 (or immediately if claims are already being processed): Billing and prior authorization teams must implement the updated step therapy criteria in all Humana commercial claim systems. Specifically: (1) When processing pharmacy claims for any of the 18 listed oral acne antibiotics, require verification of member's prior treatment history with both non-delayed release minocycline AND non-delayed release doxycycline before approving coverage; (2) Update prior authorization templates and decision trees to reflect both criteria must be met; (3) Train pharmacy benefit staff and billing processors on the two-requirement approval process; (4) Communicate to providers and patients that claims will be DENIED if prior treatment history with both medication classes cannot be documented. Update internal policy documentation and claim adjudication software rules to reflect this dual-requirement step therapy.